Diary of a social worker

The Today programme is broadcasting a major series examining care of the elderly in the UK.

One of the listeners who contacted the programme is a social worker in a hospital.

The social worker's identity is secret, but the diary reveals the work which goes on as the elderly patients are moved from hospital to home.

MRS M

Like most western countries, the UK has an ageing population

I am checking through the medical notes on Mrs M when I notice the medical entry reads that she can go home tomorrow.

When I check with the ward staff I realise no-one has informed her family or the care agency already involved.

It sometimes seems as if health think that most of what we do just takes a quick phone call to arrange rather than the endless forms we have to complete and which are audited very carefully.

Of course doctors have to be the ones to determine when someone is medically fit to go home but this is not the only criteria for safe discharge.

The environment needs to be ready too, ie is the home heated, has any necessary equipment - commode, toilet frame - been delivered, is there food in the house and if there is a carer, are they fit and ready?

Major undertaking

Under the Carers Equal Opportunities Act 2004, social workers have a legal duty to consider the needs of carers as well as clients; this duty is not imposed on the NHS in the same way.

Patients in hospital have most things done for them and get institutionalised without even realising it

When I phone the patient's carer - her daughter - she tells me she cannot manage a discharge for the following day as she needs extra time to do her mother's shopping and get the flat ready.

The carers of elderly patients are themselves often elderly or beyond retirement age and in this case the daughter does not drive, so getting to the shops and then to her mother is a major undertaking.

Many carers have already promised not to put their mother or father in a home and see no way out.

The problem is that if the elderly person has enough insight to make the decision that they want to return home, we are duty bound to honour this even if there is a risk involved.

MRS C

The proportion of over-65s in the UK is expected to rise to 22% by 2031

I stop at Mrs C's bed. She has been waiting a long time in hospital for care at home to start.

Lack of available carers when you need them is one of the main reasons why discharges get delayed, especially with elderly patients.

Social care is just as subject to the so-called postcode lottery effect as healthcare. If you live in a village or off the beaten track, chances are that not many care agencies will cover your area.

Patients in hospital have most things done for them and get institutionalised without even realising it.

Mrs C's condition has deteriorated since admission. I am not convinced she completely realises how limited her life will be once she is back home and that is one of the big problems.

It is hard to be able to challenge Mrs C's assertions sensitively without making her feel that she is failing in some way or being found wanting.

She says no-one has been near her for days and she has not seen the doctor in nearly a week.

No control

This probably is not entirely true but time goes incredibly slowly in hospital when you are mainly confined to your bed and there is nothing to differentiate one day from the next.

Few patients understand or bother with the Patientline system, which is expensive for someone on a pension - and no daily papers are delivered.

"No one tells me anything" is a complaint I often hear from patients and sometimes relatives.

It is not true, we do, but sometimes little changes from day to day so there is nothing specific to say.

Many patients feel they no longer matter as they have little control over what happens to them.

THE BED-BLOCKER

Delayed releases reflect badly on the hospital's management

The government's intention is that social services and health should work in partnership but the Community Care Act, introduced in 2003, has helped create a culture of blame and misunderstanding.

Crudely put, this act empowers health to fine social services £120 for every day a patient's discharge is delayed irrespective of the reason for the delay.

The ward makes a decision as to when the patient should be medically fit to go and issues what is known as a Section 5 form with the date of the patient's discharge.

Delayed discharges prevent new patients being admitted and reflect badly on the hospital's management of patient throughout.

The trust managers and discharge co-ordinators they employ are forced, by virtue of working to government targets, to look at statistics and numbers rather than the person behind the patient.

Nonetheless, patients who overshoot their predicted discharge date get labelled as 'bed-blockers' rather than being seen as people with their own unique and personal situation.

Although no one has the right to take up a hospital bed, I think it is a sad reflection of the times when patients born during the first 20 years of the 20th Century worriedly tell me, "I know I shouldn't be here. I know they need my bed".

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